A New Step In Solving The Mystery Of Gulf War Illness

Rebecca Ruiz
, ContributorI look at research and policies that affect our soldiers.Opinions expressed by Forbes Contributors are their own.

One of the greatest tolls on a veteran with Gulf War Illness is the crippling but mysterious fatigue that can strike unpredictably and is exacerbated after physical exercise.

It is often at the root of the condition, which is described by the Department of Veterans Affairs as a “chronic multisymptom disease.” Patients also commonly report joint and muscle pain, irritable bowel syndrome and respiratory disorders.

Researchers at Georgetown University Medical Center, who frequently heard complaints about fatigue, suspected the symptom might be related to dysfunction in the central nervous system. But making such a determination has not been easy; though cases of Gulf War Illness are now 20 years old, the science of the disease has not evolved as rapidly as one might expect given that it affects an estimated 250,000 veterans who deployed to the Gulf War. Scientists still don’t understand why or how patients become ill.

So the researchers at Georgetown designed a study to test how the brains of sick veterans responded to exercise, the results of which were published Friday in PLOS ONE. What they discovered surprised the team, said lead researcher Rakib Rayhan.

Seeing the brain's 'crutch'

They subjected 10 healthy controls and 28 veterans with Gulf War Illness to a series of exercise and memory challenges, measuring the blood flow to their brains before and after physical exertion with a functional magnetic resonance imaging scan.

First, they found that veterans had distinct responses to the exercise challenges, which were two bicycle stress tests. One group of 10 subjects had abnormally rapid heartbeats -- a clinical condition known as orthostatic tachycardia -- while the remaining veterans experienced a significant increase in pain sensitivity. Meanwhile, the control group exhibited none of these differences.

In both subgroups, the evidence suggested dysfunction in the central nervous system. Something was amiss in the way the veterans' bodies handled physical exertion, but the researchers didn’t know why. The fMRI scans, though, held important clues.

For the group with rapid heartbeats, imaging showed atrophy of the brain stem, which regulates heart rate. And in the subjects with increased soreness and discomfort, the researchers saw grey matter atrophy in adjacent regions of the brain associated with pain perception.

Before the exercise, the veterans’ brains in both groups showed increased activity while trying to complete a memory test as compared to the controls. Rayhan described this as a kind of compensation. “The brain is realizing there’s damage somewhere and something else takes over,” he said, likening the extra activity to a crutch.

Yet after exercise, the difference was shocking. When veterans in the group with increased pain took the test, their brains appeared blank, and both groups lost the compensatory activity. “You’re taking the crutch away from them by doing this exercise,” said Rayhan, adding that it might explain why veterans with Gulf War Illness feel cognitively exhausted and generally fatigued after physical exertion.

Rayhan is careful to note that the study isn’t a “linchpin” for the science of Gulf War Illness. One of the study’s limitations is its inability to demonstrate whether the brain atrophy is a result of a decades-old injury or exposure to wartime hazards like nerve agents, oil fires or pesticides. It may, for example, be the brain’s response to chronic pain.

Yet, Rayhan hopes that both VA and civilian physicians take his team's research into consideration when treating a veteran with Gulf War Illness. Another recent study by Rayhan and his collaborators found that changes in the brain may be linked to the disease.

These initial results are promising to veterans, many of whom have complained for years that doctors attribute their disease to war-related stress or a psychological disorder, and prescribe medication or treatments that don’t alleviate their symptoms.

Hope for recovery

Ronald Brown, 45, has encountered this attitude from some VA doctors, though he speaks highly of his current physician. Brown, who is considered 100 percent disabled by VA, has been diagnosed with numerous maladies – chronic fatigue syndrome, respiratory disease, fibromyalgia, migraines, sinusitis, irritable bowel syndrome and post-traumatic stress disorder – in the years since serving as an Army soldier in Desert Shield/Desert Storm from August 1990 through April 1991.

He now lives in Roanoke, Va., and participated in the Georgetown study so that it might help scientists and veterans like himself better understand Gulf War Illness.

“I was hoping it would provide answers to me about exactly what was going on,” he said. “I was hoping it would provide information to other sick veterans from the Gulf and maybe give them some peace of mind.”